In pruritus of a neurotic character a solution of the muriate of cocoaine of the strength of 4 per cent., sprayed upon the parts or applied with a camel's-hair brush, has often in the author's hands afforded relief when every other application has failed.
One of the latest publications relating to the treatment of pruritus vulvæ is a paper by Kustner,18 agreeing with Schroeder that the results of operative treatment for pruritus vulvæ are encouraging. This author publishes several cases resulting successfully. A synopsis of one will suffice to show his mode of treatment. A patient, unmarried, suffered for a long time from uterine catarrh and pruritus vulvæ: the former was relieved after prolonged treatment, but there still remained two symmetrical spots between the hymen and labia minora which were the seats of most troublesome itching and were exceedingly sensitive to touch. These portions of the mucous membrane were rich in sebaceous glands, and were also studded with small retention-cysts. The author dissected off the two elliptical portions of mucous membrane, each 1 cm. broad and 3 or 4 cm. long, and containing the small retention-cysts, and then united each wound with interrupted sutures. The pruritus entirely disappeared, and did not again return, though some years after the patient again suffered with uterine catarrh. Other cases are related by the same author, notably one case of pruritus where there was a lacerated perineum. The operation for repair of this perineum was performed, with the result of the permanent disappearance of the pruritus. The author does not give any definite rule as to how and in what cases he should have recourse to operative treatment, but, admitting that pruritus may arise from causes heretofore mentioned in this article, he asks whether those cases where secondary pathological changes have occurred in the vulvar mucous membrane cannot be definitely cured by excision of the affected portion. Not enough cases of cure of pruritus by surgical treatment have been reported to fully establish the theory of Kustner, yet it is a matter of sufficient importance to merit our attention and warrant further investigation.
18 Centralbl. f. Gyn., No. 12, 1885.
Hyperæsthesia of the Vulva.
DEFINITION.—This is a disorder first described by Thomas under the above caption.19 It consists of a hypersensitiveness of the nerves supplying some portion of the mucous membrane of the vulva. Sometimes the area of tenderness will be confined to one of the lesser lips or it will be limited to the vestibule, and in other cases a number of parts may be simultaneously affected. "It is a condition of the vulva closely resembling that hyperæsthetic state of the remains of the hymen which constitutes one form of vaginismus," and doubtless is often confounded with the latter.
19 Op. cit., p. 145.
ETIOLOGY.—It is more common about the time of change of life, and occurs more frequently among women of hysterical diathesis where there exists a morbid mental condition with a tendency to melancholia. In some instances the disease seems to be excited by vulvitis or vascular growths in the urethra.
SYMPTOMATOLOGY.—The slightest friction causes intense pain and nervousness, and even a current of cold air produces very great discomfort. Coition causes such severe pain that for this cause the subject usually consults her physician. As in vaginismus, the mental distress is often of an exaggerated character, in some instances bordering upon monomania.
PATHOLOGY.—In this disorder there are no indications of inflammation except occasional spots of erythematous redness. It is not a neuralgia in a true sense of the term, but an abnormal sensitiveness of diseased nerves supplying the vulva.
DIAGNOSIS.—The affections most liable to be confounded with this are vascular growths (or irritable caruncles) of the urethra and vaginismus, but ocular inspection and digital examination will enable the physician to determine the character of the disease.